For decades, Republicans have worked to “defund” Planned Parenthood, whose clinics provide a range of reproductive health services, including—most offensively to its detractors—abortion care. In July, the GOP majority in Congress largely accomplished that goal, at least temporarily, thanks to a provision tucked into President Donald Trump’s massive legislation extending tax breaks primarily for upper-income Americans and slashing government spending, that functionally barred federal funding for large abortion providers for one year.
The measure does not explicitly name Planned Parenthood, but it bars Medicaid funding for health care providers that offer abortions, and who received more than $800,000 in federal reimbursements in 2023 for other services such as birth control, cancer screenings, and STI treatments. Given Planned Parenthood’s size and nationwide reach, the organization’s CEO Alexis McGill Johnson warned that this would result in a loss of $700 million in federal funding and leave 200 clinics at risk of closure—primarily in states where abortion is legal.
An October report by Planned Parenthood found that since the law was signed on July 4, 20 health centers nationwide had been forced to close. Prior to September, when this provision went into effect, nearly half of all visits to Planned Parenthood clinics nationwide were from Medicaid recipients who relied on the program to cover the cost. For low-income patients who relied on Planned Parenthood for their medical needs, the threats to these clinics could have an immediate impact.
“When the clinic in their community closes, they suddenly have to either drive farther to find a different place to go get high quality care, maybe end up forgoing care altogether, putting it off until maybe it’s no longer preventive care,” said Amy Friedrich-Karnik, the director of federal policy at the Guttmacher Institute, a research organization which supports abortion access. She added that, in regions where clinics close, other medical providers may not be able to “absorb all of those patients so quickly.
“We don’t have a very cohesive health care system in this country, especially when it comes to reproductive health care,” Friedrich-Karnik continued. “Any of these types of policies that mess with the system and cause clinics to close really harm patients, especially in those communities where they already may struggle to get access to health care.”
But while Planned Parenthood was the implicit target of the provision, it is not the only health center that has been affected. In late October, Maine Family Planning—a health care organization which operates 18 clinics throughout the state and typically receives around $2 million in federal funding each year—ended primary care services in three of its locations, affecting approximately 800 patients. Their clinics remain open and are still offering reproductive health care services, but those Medicaid recipients who visited Maine Family Planning centers for general care will now need to turn elsewhere.
The third organization affected by the law is Massachusetts Health Imperatives, a network of clinics that offers a variety of health services. Abortion care and family planning account for only about 40 percent of all care provided; other services by the organization’s seven clinics include offering behavioral health care for young people, counseling for survivors of domestic and sexual abuse, and administrating the federal Nutrition Assistance Program for Women, Infants, and Children for low-income mothers. Health Imperatives CEO Julia Kehoe said that the organization was not even aware that the new law applied to them until they were mentioned in a July court filing by the administration arguing that the law did not explicitly target Planned Parenthood because Health Imperatives and Maine Family Planning would also be affected.
Kehoe said that Health Imperatives had already been struggling financially before the passage of the law, laying off ten employees earlier in the year due to rising health care costs. Grants that the organization previously received from the federal government and private foundations cannot fully cover rising prices, she said, particularly since the services the clinics offer are chronically underfunded on a federal level.
“We’re primarily government-funded, and for years, there hasn’t been enough investment in services for low-income people and services for women,” she said. This has led Health Imperatives to conclude that they need to “diversify” their funding stream away from purely relying on federal funds, with a recent $2.5 million grant through the global Action for Women’s Health initiative.
“It doesn’t fix all of our program problems, of course, because we’re a $19 million organization already at a time where we’re facing cuts and growing costs, but what it does is it allows us to not have to really take drastic action anytime the federal government makes a threat or a policy change or a funding cut,” said Kehoe.
The long-term impact of the “defund” policy is unclear. It is only in effect for one year, meaning that Congress would need to extend the provision to keep it in place. The outcome of ongoing litigation brought by 22 Democratic-led states and the District of Columbia is also yet to be seen. That lawsuit has wended its way through federal courts in recent months, with the First Circuit Court of Appeals ruling earlier in December that the Department of Health and Human Services may continue to enforce the ban while it considers the plaintiff’s motion for a stay pending appeal.
Meanwhile, the legislation also included dramatic cuts to Medicaid, which could threaten overall access to reproductive health care among young low-income women. Recent analysis by the Guttmacher Institute found that more than 2 million women between the ages of 19 and 49 could lose their Medicaid coverage over the next decade, which in turn would mean interruptions to contraceptive and other sexual and reproductive care. States may also carry an extra burden in funding Medicaid in the ensuing years.
Even if the provision relating to Planned Parenthood expires without renewal at the end of the year, Friedrich-Karnik said that the consequences of clinic closures could be permanent. “When you attack a clinic’s ability to stay open, if you are successful at closing a clinic, reopening a clinic is very, very hard,” she said. “I wouldn’t want to fool people into thinking that if it’s just one year, we can just hold our breath and eke it out, because there’s still going to be real damage done—both to the clinic system, but also then, obviously, all the patients who are then impacted.”
